Treatment and prognosis of leptomeningeal disease secondary to metastatic breast cancer: A single-centre experience

Kingston, Belinda; Kayhanian, Hamzeh; Brooks, C.; Cox, Nicola; Chaabouni, Narda; Redana, Stefania; Kalaitzaki, Eleftheria; Smith, Ian; O’Brien, Mary Claire; Johnston, Stephen; Parton, Marina; Noble, Jillian; Stanway, Susie; Ring, Alistair; Turner, Nicholas C.; Okines, Alicia

doi:10.1016/j.breast.2017.07.015

Cited by 32 publications

(15 citation statements)

References 29 publications

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“…Our results confirm that BC patients diagnosed with LMD have a dismal prognosis, with a median OS of 3.9 months only . The major clinical characteristic impacting prognosis was ECOG PS (in the overall population, as well as in the HER2+ and HER2− cohorts separately), consistently with reports from previous studies .…”

Section: Discussionsupporting

confidence: 90%

“…The major clinical characteristic impacting prognosis was ECOG PS (in the overall population, as well as in the HER2+ and HER2− cohorts separately), consistently with reports from previous studies . Other authors have also reported age and tumor subtype (according to HR and HER2 status) as clinical prognostic factors , but these results were not confirmed in our study population. However, in our study, HER2+ BC showed a trend toward better prognosis (median OS 8.4 vs. 3.2 months, statistical significance not reached, p = .066).…”

Section: Discussionsupporting

confidence: 80%

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Clinicopathological and Treatment-Associated Prognostic Factors in Patients with Breast Cancer Leptomeningeal Metastases in Relation to Tumor Biology

et al. 2018

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Leptomeningeal disease (LMD) is a devastating complication of breast cancer (BC), and its optimal therapy is still not defined. Here, patient characteristics, treatment patterns, and prognostic factors from a contemporary cohort of 153 BC-related LMD patients are reported. In multivariate analysis, Eastern Cooperative Oncology Group performance status, cerebrospinal fluid glucose levels, and having received systemic treatment were confirmed as independent prognostic factors in the overall population, whereas in human epidermal growth receptor 2 (HER2) positive BC patients, having received systemic HER2-targeted therapy was the only factor maintaining independent prognostication in multivariate analysis. These results highlight the need to consider stratification on tumor biology in the treatment of BC LMD.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 80%

Clinicopathological and Treatment-Associated Prognostic Factors in Patients with Breast Cancer Leptomeningeal Metastases in Relation to Tumor Biology

et al. 2018

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“…In 2017, Kingston et al studied 182 patients diagnosed between 2004 and 2014, of whom 90 (49.5%) had luminal ABC with LMD [ 56 ]. The authors aimed to evaluate potential predictors of survival.…”

Section: Resultsmentioning

confidence: 99%

“…Despite this, LMD continues to be understudied, and evidence for optimal treatment in BC-LMD is still limited [ 67 ]. Use of SACT has been consistently linked to better prognosis [ 12 , 14 , 56 ], but in Europe, ITT is the mainstay in LMD [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

et al. 2020

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Leptomeningeal disease (LMD) represents a devastating complication of advanced breast cancer (ABC), with survival of <5 months with multimodal treatment. The role of endocrine therapy (ET), due to its favorable toxicity profile and first-line indication in luminal ABC, appears promising in the setting of LMD, where symptom stabilization and quality-of-life preservation are the main goals; however, evidenced-based data are lacking. We conducted a thorough review of published evidence, aiming to investigate the role of ET in LMD treatment in luminal ABC. Twenty-one of 342 articles, evaluating 1302 patients, met inclusion criteria. ET use was rarely reported. New targeted agents show CNS activity. Research is lacking on the role of ET and targeted agents in BC-LMD treatment.

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“…Metastasis to the leptomeninges (LM) occurs in 5-10% of patients with metastatic breast cancer (1) and, despite advances in breast cancer treatments, the median survival after the diagnosis of BCLM remains only 3-4 months (2)(3)(4). Clinical case series have shown the strongest negative prognostic factor in LM is poor performance status (4) therefore diagnosing earlier with prompt initiation of LM-directed therapy, before significant decline in neurological function, may lead to improved survival.…”

Section: Introductionmentioning

confidence: 99%

Assessing CSF ctDNA to Improve Diagnostic Accuracy and Therapeutic Monitoring in Breast Cancer Leptomeningeal Metastasis

Fitzpatrick

Iravani

Mills

et al. 2022

Clinical Cancer Research

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Translational RelevanceThere is an urgent need for progress in the management of breast cancer leptomeningeal metastasis (BCLM). Current diagnostics are hampered by impaired sensitivity, delaying diagnosis and treatment initiation. Further, during BCLM therapy there are no quantitative response markers to guide clinical decision making. This proof-of-concept study explored the use of ulpWGS, a methodology requiring no upfront knowledge of tumor mutations, to detect ctDNA in cerebrospinal fluid (CSF) in BCLM. ctDNA was detectable in all BCLM+ patients by ulpWGS, despite frequent negative CSF cytology. Importantly, CSF ctDNA was not detected in BCLM-free patients, supporting the potential for ulpWGS as a tool to refute diagnosis. In addition, CSF ctDNA reduction, measured by ulpWGS, was associated with improved survival on intrathecal BCLM treatment. This study highlights the potential of ulpWGSassessed CSF ctDNA fraction to improve BCLM care through timely diagnosis and adaptation of therapy, and warrants larger prospective studies to test clinical validity.

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Treatment and prognosis of leptomeningeal disease secondary to metastatic breast cancer: A single-centre experience

Cited by 32 publications

References 29 publications

Clinicopathological and Treatment-Associated Prognostic Factors in Patients with Breast Cancer Leptomeningeal Metastases in Relation to Tumor Biology

Clinicopathological and Treatment-Associated Prognostic Factors in Patients with Breast Cancer Leptomeningeal Metastases in Relation to Tumor Biology

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

Assessing CSF ctDNA to Improve Diagnostic Accuracy and Therapeutic Monitoring in Breast Cancer Leptomeningeal Metastasis

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